Hemifacial Spasm: Surgical Strategies and Complications

Hemifacial spasm is a unilateral movement disorder of the facial nerve characterized by intermittent twitching of the muscles of the face. This progressive disorder can cause significant embarrassment and social withdrawal, and in severe cases lead to functional blindness. The most common cause is direct compression of the root entry zone by an ectatic blood vessel leading to local demyelination. How this demyelination leads to hyperactivity of the nerve is not precisely known, though multiple putative mechanisms exist. Here we review our institutional series of microvascular decompression of the facial nerve for the treatment of hemifacial spasm. We discuss the surgical setup, neurophysiological monitoring (including lateral spread for the purposes of predication of resolution) and postoperative complications. Potential complications include: facial palsy, gustatory or vestibular dysfunction, hearing loss, hoarseness, dysphagia, or recurrence of spasm.